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Abnormal (Dysfunctional) Uterine Bleeding

Rebecca Lauters, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Abnormal uterine bleeding (AUB) is irregular menstrual bleeding (usually heavy, prolonged, or frequent); it is a diagnosis of exclusion after establishment of normal anatomy and the ...

DIAGNOSIS

HISTORY

  • Menstrual history

    • Onset, severity (quantified by pad/tampon use, presence and size of clots), timing of bleeding (unpredictable or episodic)

    • Menorrhagia with onset of menarche is sugges...

TREATMENT

Attempt to rule out other causes of bleeding prior to instituting therapy. 

GENERAL MEASURES

Nonsteroidal anti-inflammatory drugs (NSAIDs) (naproxen sodium 500 mg BID, mefenamic acid 500 mg TI...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Once stable from acute management, recommend follow-up evaluation in 4 to 6 months for further evaluation (6).

  • Routine follow-up with a primary care or OB/GYN prov...

REFERENCES

1
Sweet MG, Schmidt-Dalton TA, Weiss PM, et al. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician.  2012;85(1):35–43.
2
Committee on Practice...

ADDITIONAL READING

  • Goldstein SR, Lumsden MA. Abnormal uterine bleeding in perimenopause. Climacteric.  2017;20(5):414–420.

  • Lethaby A, Cooke I, Rees M. Progesterone or progestogen-releasing intraut...

CODES

ICD10

  • N93.9 Abnormal uterine and vaginal bleeding, unspecified

  • N93.8 Other specified abnormal uterine and vaginal bleeding

  • N91.2 Amenorrhea, unspecified

  • N92.3 Ovulation bleeding

  • N92.2 Excessive menst...

CLINICAL PEARLS

  • AUB is irregular bleeding that occurs in the absence of pregnancy or pathology, making it a diagnosis of exclusion.

  • Anovulation accounts for 90% of AUB.

  • An EMB should be performed in all...

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